A Controlled Study of the Effect of Therapies Aimed at Adolescent and Family Psychopathology in Anorexia Nervosa

Crisp, A. H.; Norton, Kingsley; Gowers, Simon; Halek, Christine; Bowyer, Carol; Yeldham, Denise; Levett, G.; Bhat, Ashok

doi:10.1192/bjp.159.3.325

“…Similar results were obtained in the two other RCTs (8,9). The RCTs that have been done on older anorexic patients have shown minor effects (10)(11)(12). The effectiveness of cognitive behavioral therapy in bulimia has been established in RCTs (13,14), but only 50% of bulimic patients respond to treatment (13).…”

supporting

confidence: 72%

“…There is one previous study in which the effect of treatment of a group of anorexic patients was compared with a control group that received no treatment (11). However, compliance was a problem; 14 of the 20 patients in the control group (70%) left to receive treatment outside the study protocol.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

Bergh

¹

,

Brodin

²

,

Lindberg

³

et al. 2002

Proc. Natl. Acad. Sci. U.S.A.

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Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n ‫؍‬ 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9 -26.5) of treatment, but only one patient went into remission while waiting for treatment (P ‫؍‬ 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 > 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6 -36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover. E ating disorders, i.e., anorexia and bulimia nervosa, are serious health problems in young women (less than 5% of patients are men), characterized by a disordered intake of food. Thus, anorexics eat only small amounts of food and lose body weight; bulimics eat large quantities of food and vomit or use other methods to maintain normal body weight. About 1% of all women develop anorexia at the age of 14-19 years, and 1-3% develop bulimia when 20-23 years old (1). Anorexics have less than a 50% chance of recovery within 10 years after the onset of the disorder, 25% develop into chronicity, and mortality can be as high as 25% (2). Bulimics have a better prognosis, but fewer than 50% recover, and 30% continue to binge eat and purge (2, 3).There is a considerable amount of data on the time course and outcome of anorexia and bulimia nervosa (2-4), but the effect of treatment interventions has not been extensively evaluated. Hence, there is little scientific evidence for the selection of one kind of treatment rather than another. In fact, it was recently pointed out that the effects of most treatments are unknown (5). Evaluation of medical interventions should be done in randomized controlled trials (RCT) (6). Three RCTs have compared treatment effects in young anorexic patients. In the first, family therapy was effective in comparison with individual therapy in 10 patients who had been ill for about 1 year and who had been treated on average once before (7). The treatment had no effect in 70 other patients who participa...

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“…Na etiologia desses distúrbios, são várias as hipóteses psicológicas que tentam compreender o fenômeno da inanição. Parece existir um consenso entre as teorias de que os distúrbios de alimentação funcionam como uma espécie de contenção psicológica, ao interromper o desenvolvimento físico dessas adolescentes, remetendo-as ao estado pré-puberal [12][13][14][15] .…”

Section: Artigo Original Introduçãounclassified

Eating disorders in school children

Vilela¹,

Lamounier²,

Filho³

et al. 2004

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Objective: To determine the prevalence of possible eating disorders and inappropriate eating behaviors in school children from six municipalities in the state of Minas Gerais, Brazil.Methods: Cross-sectional study. The Bulimic Investigatory Test of Edinburgh (BITE), Eating Attitude Test (EAT), and Body Image Test were applied to 1,807 public school students with age ranging from 7 to 19 years.Results: According to the EAT, 241 students (13.3%), mostly females, had inappropriate eating behaviors. Nineteen students (1.1%) had a BITE score indicating a possible diagnosis of bulimia nervosa. We found that 1,059 students (59%) were unhappy with their body image; 731 students (40%) were on a diet; and 1,014 (56%) exercised to loose weight. In addition, 218 students (12%) presented binge-eating and 175 students (10%) used purgative methods to control weight. Conclusions:We observed a high prevalence of possible eating disorders and inappropriate eating behaviors in the study population, especially among female adolescents. These results are similar to those reported for developed countries. The present findings are relevant for the clinical care of children and adolescents and can serve as the basis for future works aimed at increasing our understanding of the risk factors for these illnesses. ResumoObjetivo: Este trabalho investiga a freqüência de possíveis transtornos da alimentação e comportamentos alimentares inadequados em crianças e adolescentes de seis cidades do interior de Minas Gerais, uma vez que a maioria dos autores afirma uma prevalência maior em países desenvolvidos. Resultados: De acordo com a auto-escala EAT, 241 alunos (13,3%) apresentaram possíveis transtornos de alimentação, com predominância significativa do sexo feminino. E, segundo a auto-escala BITE, 19 estudantes (1,1%) apresentaram um escore compatível com bulimia nervosa. Encontramos 1.059 alunos (59%) insatisfeitos com sua imagem corporal, 731 alunos (40%) em uso de dieta para emagrecer e 1.014 alunos (56%) que praticavam atividade física com a finalidade de perder peso. Os episódios bulímicos foram encontrados em 218 alunos (12%), e 175 alunos (10%) utilizavam métodos purgativos para perder peso. MétodosConclusões: Este estudo mostra uma alta prevalência de possíveis transtornos alimentares na população estudada, assim como comportamentos alimentares inadequados, principalmente em adolescentes do sexo feminino. Os resultados são semelhantes aos encontrados nos países considerados desenvolvidos. Concluímos que esses achados são relevantes para a clínica da criança e do adolescente e que podem proporcionar futuros trabalhos onde poderemos compreender melhor os possíveis fatores de risco para esses transtornos da alimentação. ARTIGO ORIGINAL IntroduçãoAnorexia nervosa e bulimia nervosa são transtornos alimentares freqüentemente crônicos e associados com um alto índice de comorbidade 1 , sendo a bulimia mais freqüente que a anorexia. Sua prevalência é alta, com 90 a 95% dos casos ocorrendo no sexo feminino 2 . Apesar de a prevalência ...

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“…There appears to be a consensus between these theories that eating disorders act as a form of psychological deterrent by interrupting the physical development of these adolescents, taking them to the prepubertal stage. [12][13][14][15] With regard to genetic factors, several studies suggest that females who have anorexic relatives have a greater propensity for anorexia. According to the literature review conducted by Woodside, based on twin studies, the inheritability of anorexia and bulimia corresponds to 75 to 80% and 45 to 55%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Transtornos alimentares em escolares

Vilela¹,

Lamounier²,

Filho³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: To determine the prevalence of possible eating disorders and inappropriate eating behaviors in school children from six municipalities in the state of Minas Gerais, Brazil.Methods: Cross-sectional study. The Bulimic Investigatory Test of Edinburgh (BITE), Eating Attitude Test (EAT), and Body Image Test were applied to 1,807 public school students with age ranging from 7 to 19 years.Results: According to the EAT, 241 students (13.3%), mostly females, had inappropriate eating behaviors. Nineteen students (1.1%) had a BITE score indicating a possible diagnosis of bulimia nervosa. We found that 1,059 students (59%) were unhappy with their body image; 731 students (40%) were on a diet; and 1,014 (56%) exercised to loose weight. In addition, 218 students (12%) presented binge-eating and 175 students (10%) used purgative methods to control weight. Conclusions:We observed a high prevalence of possible eating disorders and inappropriate eating behaviors in the study population, especially among female adolescents. These results are similar to those reported for developed countries. The present findings are relevant for the clinical care of children and adolescents and can serve as the basis for future works aimed at increasing our understanding of the risk factors for these illnesses.

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A Controlled Study of the Effect of Therapies Aimed at Adolescent and Family Psychopathology in Anorexia Nervosa

Cited by 257 publications

References 17 publications

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

Eating disorders in school children

Transtornos alimentares em escolares

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